.Guangwen Xu
Abstract: This paper discusses the regulation of substances and energy within the living human body in Huangdi Neijing ［The Yellow Emperor’s Inner Canon］in terms of the regulation of yin, yang, construction, and defense; the mutual transformation, engendering, and regulation of qi, blood, and fluids; the mutual transformation, engendering, and regulation of essence, qi, and spirit; and the mutual transformation, engendering, and regulation of essence, blood, and marrow.
Keywords: Huangdi Neijing ［The Yellow Emperor’s Inner Canon］, living human body, regulation of substances and energy
In Huangdi Neijing ［The Yellow Emperor’s Inner Canon］, the physiological activity of the living human body is regulated by dynamic balance. The living human body’s substances, energy, and physiological functions are reflected in the processes that regulate life activities.
1. Regulation of yin and yang
Huangdi Neijing says: “The physical appearance of human life, it does not leave yin and yang.”［1］ “Once yin and yang ［qi］ are balanced, the essence qi will be luminous. Once the physical constitutes one entity with the qi, the spirit will be retained internally.”［2］“When the yin and yang are balanced and sealed, then essence and spirit are in order.”［1］ The normal activities of life result from the maintenance of balance and coordination between yin and yang. Mutual interaction, restraint, waxing and waning, transformation, and regulation between yin and yang enable the body to maintain a dynamic yin-yang balance.
2. Regulation of construction and defense
Huangdi Neijing says:
a.“The construction qi, that is the essence qi of water and grain. When it is harmoniously balanced in the 5 viscera and when it is dispersed throughout the 6 bowels, then it can enter the vessels. Hence, it follows the vessels upwards and downwards, penetrates the 5 viscera, and connects the 6 bowels. The defense qi, that is the violent qi of water and grain. ［…］ Hence, it moves inside the skin and in the partings of the flesh. It steams against the huang-membrane, and it spreads in the chest and abdomen.”［1］
c.“For the way of the construction qi, the intake of grain is its most precious function. The grain enters the stomach. The qi is forwarded to the lung. They flow into the center, and they disperse toward the outside.”［2］“The defense qi ［…］ At first, they move into the region of the partings of the flesh and the skin in the 4 limbs. They never rest. ［…］ They move to the 5 viscera and 6 bowels.”［2］
d.“The construction qi seep out as liquid and humor, and they pour into the vessels. There they are transformed to blood, serving to nourish the 4 limbs. Internally they pour into the 5 viscera and 6 bowels.”［2］
e. “Those floating qi that do not move along the channels, they are the defense qi. The essence qi that move in the channels, they are the construction qi. The ［qi moving through］ the yin and yang ［channels］ alternate; they penetrate the interior and the exterior alternately, like a ring without a beginning or end.”［2］
f. “The construction ［qi］ are in the vessels. The defense ［qi］ are outside the vessels. They circulate without stopping. After 50 ［circulations］, a grand meeting happens. Yin and yang ［qi］ penetrate each other’s realm. This is like a ring without end.”［2］
g. “Now in the blood vessels the construction and defense ［qi］ flow without cease.”［2］
All of these passages explain how the construction and defense qi circulate externally in the flesh and skin, and internally move through the viscera and bowels, constantly nourishing the whole body in an endless cycle. The construction and defense qi regulate and affect each other, and harmonize the internal and external, nourishing the flesh, skin, and internal organs.
3. Mutual transformation and regulation of qi, blood, and fluids
Chapter 30 of Ling Shu ［The Magic Pivot］, entitled “Understanding Qi”, states: “Huang Di said: ‘What is qi?’ Qi Bo said: ‘When the upper burner opens and sends something out to pass on the flavors of the 5 grains, to steam the skin, to fill the body, to moisten the body hair, in the same way as mist and dew provide humidity, then that is what is what is called qi.’ ‘What is liquid?’ Qi Bo said: ‘That which is released to flow out of the skin structures, when sweat leaves profusely, that is what is called liquid.’ ‘What is humor?’ Qi Bo said: ‘When the grains enter ［the body］ and fill it with qi, then a viscous liquid pours into the bones, enabling the bone connections to bend and stretch. ［The qi］ flow out to fill the brain with marrow and they provide the skin with dampness. That is what is called humor.’ ‘What is blood?’ Qi Bo said: ‘The center burner receives the qi. It extracts their juice and transforms it into something red. That is what called blood.’” This passage explains what qi, blood, and fluids are, as well as their source and physiological functions.
a.“Man has only blood and qi.”［1］ “The blood is spirit qi.” “The spirit, that is the essence qi of water and grain.”［2］In Nan Jing ［The Classic of Difficult Issues］, the section on “8 Difficulties” states: “Qi is the root of man.”
b.“When liquid and humor are harmonized, they turn red and are transformed into blood.”［2］This means that liquid engenders blood.
c.“The construction qi seep out as liquid and humor, and they pour into the vessels. There they are transformed to blood.”［2］This means that qi (construction qi) engenders liquid, which in turn engenders blood.
d.“The qi received there are discharged as dregs, steamed as liquid and humor, and transformed to fine essence. ［The latter］ pours upward into the lung vessel where it is transformed to blood.”［2］This means that qi is transformed to engender liquid and humor. Liquid pours into the vessels and is transformed and reddened to become blood, which refers to the fact that liquid engenders blood.
e.“The 5 flavors enter through the mouth and are stored in the intestines and in the stomach. When the flavors have a place where they are stored, this serves to nourish the 5 qi. When the qi are engendered in harmony, and when liquid and humor complete each other, then the spirit will be engendered by itself.”［1］ “The qi of foods and the 5 flavors, this serves to nourish the qi of the 5 viscera. When the qi of the viscera are harmonized, then they can transform liquid and humor. When liquid and humor are harmonized, the spirit will be produced naturally.”［1］
f. “It is simply impossible that there could a place not passed through by the qi. This is like the flow of water, like the movement of the sun and moon; they will never stop. The fact is: The ［qi of the］ yin vessels circulate through the viscera. The ［qi of the］ yang vessels circulate through the bowels. This is like a ring without end. And nobody knows the underlying set-up. Where it ends, there is a new beginning. The qi that spill over, they moisten the viscera and bowels internally. Externally they moisten the skin structures.”［2］
g. “［When］ the blood vessels are in harmony and disinhibited, essence and spirit are sedentary.”
h. “Now in the blood vessels the construction and defense ［qi］ flow without cease.”［2］These passages indicate that the transformation of qi, blood, and fluids all originate from the fine essence of water and grain, as well as their physiological functions of mutually transformation and regulation. Qi, blood, and fluids are the basic substances that constitute the human body and maintain human life activities. They originate from the constant transformation and supplementation of the fine essence of water and grain that is absorbed by the spleen and stomach. Under the control of the viscera, bowels, and heart spirit, these substances mutually permeate, promote, transform, depend on, restrain, and regulate each other to maintain balance.
4. Mutual transformation and regulation of essence, qi, and spirit Huangdi Neijing says:
a.“A person’s blood and qi, essence and spirit, it is with them that life is provided and one’s nature and existence are upheld.”［2］“The 5 viscera are responsible for storing the essence.”［2］
b.“The construction and defense are essence qi. The blood is spirit qi.”［2］“The essence is the root of the body.”［1］In Nan Jing ［The Classic of Difficult Issues］, the section on “8 Difficulties” states: “Qi is the root of man.” Huainanzi ［Writings of the Huainan Masters］states: “The spirit is the governance of life.”
c.“Qi turns to essence.”“Essence transforms into qi.”［1］
d.“The spirit, that is the essence qi of water and grain.”［2］
e.“When 2 essences clash, that is called spirit.［2］This explains how essence, qi, and spirit are all derived from the transformation of the fine essence of water and grain.
Essence, qi, and spirit mutually nourish, engender, depend on, transform, interact, supplement, and regulate each other. Qi can produce essence, essence can transform into qi, and essence qi fosters the spirit. Essence and qi are the material basis of the spirit qi. The spirit is produced on the basis of the essence qi. So, when essence and qi are sufficient, the spirit will be effulgent. The spirit dominates and regulates the transformation of essence qi and qi movement. At the same time, the movement of qi reflects spirit qi.
Essence, qi, and spirit are the “3 treasures” of the human body. The origin of human life is “essence”, the driving force of life is “qi”, and the manifestation of life is the activity of the “spirit”. So, when essence is sufficient, there will be enough qi; when there is enough qi, the spirit will be effulgent. The effulgence of the spirit shows that there is enough qi, and the fact that there is enough qi shows that essence is sufficient.
5. Mutual transformation and regulation of essence, blood, and marrow
Huangdi Neijing says: “The kidneys store essence.” “The kidneys rule the bones.” “The kidneys rule the body’s bones and marrow.”［1］ “The kidneys store the qi of the bones and of the marrow.”［1］“The kidneys generate the bones and the marrow; the marrow generates the liver.”［1］
The meaning of this passage is that the kidney essence transforms into marrow. The fact that “the marrow generates the liver” is the process of water engendering wood, which refers to kidney essence transforming into liver blood. Because the liver and the kidneys share the same origin, essence and blood come from the same source. The kidneys store essence and the liver stores blood, so essence generates blood. As stated in volume 8 of Zhangshi Yitong ［Zhang’s Clear View of Medicine］, entitled “On Various Blood ［Signs］”: “The essence that returns to the kidneys serves as essence. ［When］ essence is not discharged, it returns to the liver, where it is transformed to clear blood.” Another meaning is that the marrow can produce blood and the liver stores blood, so the fact that “the marrow generates the liver” implies that the bone marrow engenders the liver blood.
“At the beginning of a person’s life, the essence is first to form. Once the essence has formed, brain and marrow are generated.”［2］“The marrow is ruled by the brain.”［1］“The brain is the sea of marrow.”［2］“Bones and marrow are solid and firm, and the qi and blood follow their usual course. In this situation, the internal and external are balanced and harmonious ［…］ the ears and eyes are clear.”［1］These lines describe how essence engenders marrow and marrow is connected to the brain.
The passages above explain how blood can engender essence and essence can transform into blood. “Essence and blood share the same origin”, mutually transforming and engendering each other. The essence engendered by blood is stored in the kidneys, which store essence and rule the bones. “The kidneys engender bone marrow”; the marrow transformed from kidney essence is stored in the bones. The blood that is engendered by the bone marrow circulates to nourish the whole body. Therefore, essence, blood, and marrow share the same source and mutually transform and regulate each other. When blood is sufficient, there is enough essence, and when there is enough essence, the marrow is full. When the marrow is full, blood is effulgent. The kidneys store essence, which engenders marrow. The marrow of the spinal cord connects to the brain, so marrow fills the brain; hence, “the brain is the sea of marrow”. When the “bones and marrow are solid and firm”, marrow is effulgent and goes up to fill the brain. “When the brain marrow is full, the ears and eyes are clear, and one is full of vigor.” At the same time, the brain spirit controls the 5 viscera and 6 bowels, and regulates the source of qi and blood transformation, enabling the endless supply of essence and blood to ensure the normal regulatory functions of the transformation and circulation of essence, blood, and marrow in the body.
Therefore, the theory of Huangdi Neijing explains how construction, defense, qi, blood, liquid, humor, essence, and marrow serve as substances and energy to support the activities and various movements in the living human body. The mutual transformation and regulation of construction, defense, qi, blood, liquid, humor, essence, and marrow maintain the dynamic balance of normal physiological function. Moreover,the life activities and movements in the human body are “centered on the 5 viscera”; under the control of the heart spirit, they take on specific physiological roles. Yin, yang, construction, defense, qi, blood, essence, marrow, and essence spirit all exist in the living body, and are reflected in the regulatory processes of life activities. If “yin and yang are dissociated, then the ［flow of］ essence qi is interrupted.” The spirit will then be dissipated, life will end, and with it, the substances, energy, and functions will also disappear.
References
［1］. Cheng Shide, proofreader and translator. Huangdi neijing suwen ［The yellow emperor’s inner canon: plain questions］. Beijing: Chunqiu Chubanshe ［Spring and Autumn Publishing House］, 1988, 08
［2］. Xin Ruwen, ed. Huangdi neijing lingshu ［The yellow emperor’s inner canon: the magic pivot］ Wuhan: Huazhong Keji Daxue Chubanshe ［Huazhong University of Science and Technology Press］, 2017. 06
［3］. Author: Paul U. Unschuld. Huang Di Nei Jing Su Wen. Publisher : University of California Press，08-19-2011. Language : English ISBN-10: 0520292251 ISBN-13 : 9780520292253
［4］. Author: Paul U. Unschuld. Huang Di Nei Jing Ling Shu. Publisher: University of California Press, 16-09-2016. Language : English ISBN-10 : 0520292251 ISBN-13 : 9780520292253
Author information:
Guangwen Xu graduated from Shanghai University of TCM in China and holds a doctoral degree. Xu is a chief TCM physician and a British registered practitioner of Chinese medicine.
Email: [email protected]
簡述《內經》生命人體的物質能量調節
徐廣文
摘要：本文從陰陽調節、營衛調節、氣血津液的相互化生，相互調節、精氣神相互化生，相互調節、精血髓相互化生，相互調節，簡述了《內經》生命人體的物質和能量調節的主要部分。
關鍵詞:黃帝內經;生命人體;物質能量調節
《內經》 生命人體是動態平衡的生理調節；生命人體的物質能量和生理功能，皆體現在生命活動的調節過程中。
1. 陰陽調節
“人生有形，不離陰陽。”［1］ “調陰與陽，精氣乃光，合形與氣，使神內藏。故曰：上工平氣。”［2］ “陰平陽秘，精神乃治。”［1］人體的正常生命活動，是陰陽兩個方面保持着協調平衡的結果。陰陽之間的相互作用，相互制約，消長轉化，相互調節，使機體保持一種動態的陰陽平衡。
2. 營衛調節
經云：“榮者水穀之精氣也，和調於五臟，灑陳於六腑，乃能入於脈也。故循脈上下貫五臟，絡六腑也。衛者水穀之悍氣也。…… 故循皮膚之中，分肉之間，燻於肓膜，散於胸腹。”［1］ “營氣之道，內穀為寶。穀入於胃，乃傳於肺，流溢於中，佈散於外。”［2］“衛氣者，……先行於四末分肉皮膚之間，而不休者也。……行於五臟六腑。”［2］ “營氣者，泌其津液，注之於脈，化以為血，以榮四末，內注五臟六腑。”［2］ “其浮氣之不循經者，為衛氣；其精氣之行於經者，為營氣。陰陽相隨，外內相貫，如環之無端。”［2］ “營（氣）在脈中，衛（氣）在脈外。營周不休，五十而復大會。陰陽相貫，如環無端。”［2］ “夫血脈營衛，周流不休。”［2］
皆說明營衛者，外循肌膚，內行臟腑, 營周不休，如環無端。營衛之氣相互調節，相互為用，調和內外，營養肌膚內臟。
3.氣血津液的相互化生調節
《靈樞. 決氣篇》：“帝曰：何謂氣？岐伯曰：上焦開發，宣五穀味，燻膚、充身、澤毛，若霧露之溉，是謂氣。何謂津？岐伯曰：腠理發泄，汗出溱溱，是謂津。何謂液？岐伯曰：穀入氣滿，淖澤注於骨，骨屬屈伸，泄澤補益腦髓，皮膚潤澤，是謂液。何謂血？岐伯曰：中焦受氣，取汁變化而赤，是謂血。” 指明了何為氣血津液，氣血津液的來源，和其生理功能。
“人之所有者，血與氣耳”［1］ “血者，神氣也。” “神者，水穀之精氣也。”［2］《難經·八難》：“氣者，人之根本也”。“津液和調，變化而赤為血。”［2］為津生血。“營氣者，泌其津液，注之於脈，化以為血。”［2］為氣（營氣）生津，津生血。“此所受氣者，泌糟粕，蒸津液，化其精微，上注於肺脈，乃化而為血。”［2］為氣化生津液，津注於脈，變化而赤為血，為津生血也。“五味入口，藏於腸胃，味有所藏，以養五氣，氣和而生，津液相成，神乃自生。”［1］ “食氣五味以養五臟之氣，臟氣調和則能化生津液，津氣和調，神乃自然產生。”“氣之不得無行也，如水之流，如日月之行不休，故陰脈榮其臟，陽脈榮其腑，如環之無端，莫知其紀，終而復始。其流溢之氣，內溉臟腑，外濡腠理。”［2］ “血脈和利，精神乃居。”［2］ “血脈營衛，周流不休。”［2］
這些經文說明了氣血津液的化生，皆源於水穀精微，和其相互化生調節的生理功能。
氣血津液是構成人體和維持人體生命活動的基本物質，皆源於脾胃所吸收的水穀精微不斷地化生補充。其在臟腑的調節和心神的主宰下，相互滲透、相互促進、相互轉化、相互依存、相互制約、相互為用和相互調節以保持平衡。
4.精氣神相互化生，相互調節
“人之血氣精神者，所以奉生而周於性命者也。”［2］ “五臟主藏精者也。”［2］ “營衛者，精氣也；血者，神氣也。”［2］ “夫精者，身之本也。”［1］《難經·八難》：“氣者，人之根本也”。《淮南子·原道訓》說：“神者，生之制也。”“氣歸精”，“精化為氣。”［1］ “神者，水穀之精氣也。”［2］“兩精相搏謂之神。”［1］說明精、氣、神，皆源於水穀精微所化生。為生命之本，人體之神。
精、氣、神三者之間是相互滋生、互相依存，互相轉化、相互為用，相互助長，相互調節。氣能生精，精能化氣，精氣育神。精、氣是神氣的物質基礎，神是在精氣的基礎上產生的。所以，精氣充盈則神旺，神又主宰精氣的化生，氣的運動。而氣的運動反應神氣。
精氣神為人身之“三寶”。人的生命起源是“精”，維持生命的動力是“氣”，而生命的體現就是“神”的活動。當精充氣就足，氣足神就旺；神旺說明氣足，氣足說明精充。
5. 精血髓相互化生，相互調節：
“腎藏精”；“腎主骨”；“腎主身之骨髓。”［1］“腎藏骨髓之氣也。”［1］“腎生骨髓，髓生肝。”［1］
此經文之意是腎精化生骨髓。而“髓生肝”者，水生木也，腎精化生肝血也。因肝腎同源，精血同源也，腎藏精，肝藏血，則精生血也。如《張氏醫通·諸血門》說：“歸精於腎而為精；精不泄，歸精於肝，而化清血。” 另之意，髓能生血，肝藏血，故“髓生肝”者，骨髓生肝血也。
“人始生，先成精，精成而腦髓生”［2］“髓者，以腦為主。”［1］“腦為髓之海”［2］“骨髓堅固，氣血皆從。如是則內外調和……耳目聰明。”［1］說明精生髓，髓通於腦。
以上經文說明血能生精，精能化血；“精血同源”，相互化生；和血生之精藏於腎，而腎藏精，主骨，“腎生骨髓”，腎精所化生之髓藏於骨，骨髓而化生的血，而進入血液循環，以濡養全身。故精血髓，三者同源且相互化生，相互調節。血盈則精充，精充則髓滿，髓滿則血旺；腎藏精，精生髓，脊髓上通於腦，則髓充腦；“腦為髓之海”。“骨髓堅固”，則生髓旺盛而上充於腦，“腦髓盈滿，則耳目聰明，精力充沛”。
同時，腦神主宰五臟六腑，調節氣血生化之源，使精血源源不斷地得以充實，保證體內精血髓的相互化生和循環調節功能正常。
所以，《黃帝內經》的理論說明生命人體的活動和各種運動都是以營衛、氣血、津液、精髓為物質和能量；營衛、氣血、津液、精髓的相互化生，相互調節，保持了動態平衡的正常生理功能；人體活動和各種運動，“以五臟為中心”，在心神的主宰下，發揮着特殊的生理作用；陰陽、營衛、氣血、精髓、精神，皆存在於生命體，體現在生命活動的調節過程中。若“陰陽離決，精氣乃絕。” 則神散而生命終結，能量物質和功能也隨之而消失。
參考文獻
References
［1］. 程士德校譯.《黃帝內經素問 》.北京: 春秋出版社出版， 1988， 08
［2］. 邤汝雯編著《黃帝內經.靈樞》 武漢：華中科技大學出版社，2017. 06
［3］. Author: Paul U. Unschuld. Huang Di Nei Jing Su Wen. Publisher : University of California Press，08-19-2011. Language : English ISBN-10: 0520292251 ISBN-13 : 9780520292253
［4］. Author: Paul U. Unschuld. Huang Di Nei Jing Ling Shu. Publisher: University of California Press, 16-09-2016. Language : English ISBN-10 : 0520292251 ISBN-13 : 9780520292253
作者簡介:
徐廣文,畢業於上海中醫藥大學，博士，主任醫師。英國注冊中醫師。
